White Coat, Black Art·DR. GOLDMAN'S BLOG

The case for decriminalizing drugs in Canada

Officials in Toronto and Vancouver say Canada should decriminalize possession of drugs for personal use. @NightshiftMD explains why.
Naloxone, which has become much easier to access since the overdose crisis began, has revived thousands of people from the brink of death during opioid overdose, according to Dr. Bonnie Henry. (Rafferty Baker/CBC)

Officials in two of Canada's biggest cities are calling on Ottawa to decriminalize personal drug use and possession.

Late last month, Toronto's medical officer of health made the bold request. It follows that of Vancouver's mayor in March of this year. Both say it's time to treat drug use as a health issue instead.

On Monday, Toronto's Board of Health decided to call on Ottawa to decriminalize all drugs for personal use, and to convene a task force to explore options to regulate drugs based on a public health approach.

In March, Vancouver Mayor Gregor Robertson made explicit calls to decriminalize drug use. The mayor did not ask police to stop arresting people for drug possession but did echo calls for police to put more effort into helping people get services instead of jailing them.

There are several reasons why they have made that call. Vancouver's mayor has said it's a direct response to the opioid crisis that has seen at least one overdose death per day in that city. Ten per cent of the more than 4,000 Canadians believed to have died from opioid overdoses last year occurred in Vancouver.

B.C. provincial health officer Bonnie Henry has said that treating simple possession of drugs as a crime does not prevent drug use but does stigmatize people and turns them into hardened criminals who are exposed to even more harm while incarcerated.

Toronto's medical officer of health said the evidence on the health and social harms of criminalization and the experience of countries that have decriminalized drug use support the need for a new approach in Canada. 

So, what do they mean by using a public health approach to tackle the drug problem? Instead of prosecution, a public health approach means offering drug users treatment and prevention options that are backed by clinical evidence.

It also means engaging those who commit criminal offences in treatment during and following incarceration or instead of it. In that way of thinking, the main priorities are to prevent relapse and recidivism.

A public health approach also includes distributing naloxone kits to prevent overdose deaths, treating infectious diseases associated with drug use such as HIV and hepatitis C and providing treatment for associated mental health conditions.

Portugal's drug decriminalization 

This approach has been wildly successful in Portugal. In the 1980s, heroin was introduced to the Algarve coast of Portugal. At the peak of the crisis, one in 10 people in the southern part of the country were heroin users. The rate of HIV infection was the highest in the European Union.

In 2001, Portugal decriminalized the possession and use of all illicit substances. Anyone caught with a personal supply was given a warning and a small fine.

They also had to appear before a local commission consisting of a physician, a lawyer and a social worker to hear about treatment, harm reduction and support services.

Following those moves, the crisis stabilized. Since then, rates of problem drug use, overdose deaths, crime and incarceration, HIV and hepatitis C infections plummeted.

Observers say decriminalization was not the sole factor behind such a radical change in thinking. It reflected a culture shift going on in the country that viewed people who use drugs as having a disease instead of being misfits of society. Instead of being called drug addicts or junkies, they were referred to as people who use drugs. 

The decision to decriminalize drug use and treat it as a public health problem is a political decision.

If a majority of Canadians say they want the federal government to follow Portugal's example, I predict they'll give it serious attention. 

I suspect that a significant proportion of Canadians might be uncomfortable legalizing drug possession for personal use. Despite a lot of evidence to the contrary, I suspect many Canadians still believe that decriminalization encourages drug use and increases the risk of harm.

It's a harder sell than some might believe.


Dr. Brian Goldman is a veteran ER physician and an award-winning medical reporter. As host of CBC Radio’s White Coat, Black Art, he uses his proven knack for making sense of medical bafflegab to show listeners what really goes on at hospitals and clinics. He is the author of The Night Shift and The Power of Kindness: Why Empathy is Essential in Everyday Life.